Provider Demographics
NPI:1063421220
Name:BALTIMORE, PEGGY S (LCSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:S
Last Name:BALTIMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 38
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-7606
Mailing Address - Country:US
Mailing Address - Phone:706-565-0555
Mailing Address - Fax:706-565-0556
Practice Address - Street 1:2901 UNIVERSITY AVE
Practice Address - Street 2:SUITE 38
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-7606
Practice Address - Country:US
Practice Address - Phone:706-565-0555
Practice Address - Fax:706-565-0556
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW# 10891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical